[Intraepithelial phototherapeutic keratectomy and alcohol delamination for recurrent corneal erosions--two minimally invasive surgical alternatives]. / Intraepitheliale Phototherapeutische Keratektomie und Alkohol-Abrasio zur Therapie der rezidivierenden Erosio corneae - zwei minimalinvasive chirurgische Alternativen.

BACKGROUND: Phototherapeutic keratectomy (PTK) has become established as a successful therapy for recurrent corneal erosions. After epithelial debridement, Bowman's lamella and anterior stroma are ablated by the Excimer laser. We have evaluated two alternative stroma-sparing treatment options, intraepithelial PTK, and alcohol delamination. PATIENTS AND METHODS: All treatments were performed in the relapse-free period. 17 eyes with recurrent corneal erosions were treated with intraepithelial PTK: from the intact epithelium, 12 - 25 microm of tissue were ablated by the Excimer laser (group I). Alcohol delamination was performed in 13 eyes (group II). Follow-up time was between 6 months and 7 years (mean 4.2 years). RESULTS: Both methods turned out to be safe, no refractive changes were detectable. After intraepithelial PTK, we saw a cumulative recurrence rate of 12 % after 1 year, 18 % after 2 years, and 24 % after 3 years, and a temporary subepithelial scaring was seen. Alcohol delamination resulted in a recurrence rate of 15 % during the whole follow-up time (no statistically significant difference compared to intraepithelial PTK), showing no haze or scarring. CONCLUSION: Both minimally invasive, stroma-sparing methods were effective for the treatment of trauma-associated recurrent erosion. The ablation of Bowman's lamella or anterior stroma does not seem to be necessary. However, for basal membrane dystrophy, we recommend PTK after epithelial debridement for the partial ablation of Bowman's lamella.

[Vitreoretinal operations with local anesthesia]. / Vitreoretinale Operationen in Lokalanästhesie.

The objective of this prospective study was to evaluate the intra- and postoperative pain in vitreoretinal surgery under retrobulbar anesthesia (RBA) in 53 patients, considering objective stress parameters such as blood pressure, heart rate and plasma concentration of cortisol (PCC). The level of pain was graded on a standard 4-point nominal scale. Mean pain score after RBA was 1.04, decreased perioperative to 0.77, and increased again with a maximum at 8 h postoperative to 1.15. The quality of RBA significantly correlated with the patient's pain during and at the end of surgery (P < 0.001). At the end of surgery (P < 0.001). At the end of surgery pain also correlated with the duration of surgery (P < 0.01). In 14 patients PCC was measured preoperatively. PCC decreased significantly after oral premedication with Lorazepam (18.4 to 12.6 micrograms/dl, P < 0.001). In the further course of surgery no significant differences in PCC could be detected in 26 patients. Pain during the operation correlated significantly with intraoperative (P = 0.01) and postoperative (P = 0.03) PCC. The objective stress parameters blood pressure and heart rate did not differ significantly during surgery. Of our patients, 77.4% decided that they would choose RBA again in case of ocular surgery.

Early pars plana vitrectomy without buckling procedure in cytomegalovirus retinitis-induced retinal detachment.

BACKGROUND: Retinal detachments induced by cytomegalovirus (CMV) retinitis can often be treated successfully with a buckling procedure combined with vitrectomy and silicone oil instillation, but this technique yields varying visual results. METHODS: To minimize operational trauma, pars plana vitrectomy and silicone oil instillation without additional buckling was performed in a series of 11 consecutive patients with acquired immune deficiency syndrome (AIDS) and CMV-retinitis-induced retinal detachment. Surgery was performed early in the course of the retinal detachment: 6 patients (55%) had an attached macula, and 7 patients (64%) had a visual acuity of 20/200 or better. RESULTS: After a mean follow-up period of 5 months (range, 1-9 months) 9 patients (82%) had a completely reattached retina and 9 patients (82%) had visual acuity of 20/200 or better. The macula was reattached in all patients. A localized detachment of the inferior retina was noted in 2 patients (18%), and a second operation was required in one eye. Significant cataract formation occurred in two patients during the follow-up period. Proliferative vitreoretinopathy and increased intraocular pressure were not observed. CONCLUSION: Early vitrectomy without additional buckling procedures is justified in patients with CMV-associated retinal detachment because it stabilizes the retinal situation without major complications and improves visual function.